The proposal requests support for investigation of a hypothesis to improve the care of terminal cancer patients in a comprehensive cancer center. Testing the hypothesis will be followed by application of interventions designed to correct deficiencies and improve outcomes. The hypothesis states that agreement, or congruence, concerning whether the objectives of treatment are Phase II (cure and extended useful life) or Phase III (relief of symptoms and improved quality of remaining life) is an essential factor determining outcome of the terminal phase. This "plant congruence" involves the patient, family, and medical care team. If the hypothesis is demonstrated to be true, it will have a major effect on teaching and care patterns in our hospital system.